Women with endometriosis say menstrual leave and flexible working would help most, as research estimates yearly income losses of €1,757 (£1,502).

Pain and fatigue were linked to more frequent work absences and reduced job performance.

The first large-scale study of its kind in Central and Eastern Europe estimated that women with the condition lose an average of €1,757 in income each year, roughly equal to one month’s average salary in Hungary.

The estimate covers income lost through work absences and does not include reduced productivity while at work or healthcare costs.

Researchers at Semmelweis University analysed data from 566 women with endometriosis and 447 women without the condition.

Using internationally validated questionnaires, they assessed work productivity, absenteeism and work ability.

Women with endometriosis lost an average of 12.7 working hours over four weeks because of health-related problems, compared with 5.7 hours among women in the control group.

Based on the hours missed, researchers estimated an average annual income loss of €1,757 for each affected woman.

Dr Dóra Balogh, assistant professor in the Department of Obstetrics and Gynaecology at Semmelweis University and senior author, said: “The impact of endometriosis is not only a health issue but also a major social and economic one.

“The condition affects women during one of the most active stages of their lives, meaning it can influence employment, career development, and long-term financial security.”

Endometriosis affects about 10 per cent of women of reproductive age worldwide.

It is a chronic gynaecological condition in which tissue similar to the lining of the womb grows outside the womb, causing chronic pelvic pain, painful periods, fatigue and, in some cases, infertility.

Symptoms often persist for many years before the condition is diagnosed.

The study found that 42 per cent of women with endometriosis had poor work ability, compared with 17.9 per cent of women in the control group.

Poor work ability means a person’s health makes it harder to perform their job and increases the risk of prolonged work disability or leaving the workforce.

Dr Dominika Miklós, resident physician in the Department of Obstetrics and Gynaecology at Semmelweis University and first author, said: “The most surprising finding was that nearly half of the women with endometriosis fell into this category.

“Without appropriate support, the condition may not only make day-to-day work more difficult but also threaten women’s ability to remain in the workforce over the long term.”

Researchers also found that many workplaces were not adequately prepared to support employees with endometriosis.

Some 54 per cent of respondents said their employer had little or no knowledge of the condition, while only 17 per cent believed their workplace was sufficiently informed about it.

Participants said they would most value menstrual leave, flexible working hours, remote or hybrid working and greater understanding and support from employers.

Some European countries, including Spain and Portugal, already allow menstrual leave in certain circumstances.

The research formed part of the international FEMaLe, or Finding Endometriosis with Machine Learning, programme, launched in 2020.

At Semmelweis University, the project is led by Dr Attila Bokor, associate professor in the Department of Obstetrics and Gynaecology.

The programme aims to improve understanding of endometriosis, promote earlier diagnosis and investigate its health, social and economic impact.

Researchers said it was the first comprehensive study in Central and Eastern Europe to examine work productivity, work ability and workplace support at the same time.

The findings were consistent with studies from Western Europe and Australia, suggesting the effect of endometriosis on working life is similar across regions.

Researchers concluded that flexible working arrangements and better-informed employers could help women with endometriosis remain in the workforce.

By Ruby Raut, founder, WUKA

Every time we post a dad talking to his daughter about periods, the internet seems to split in two.

One side says: “This is brilliant. I wish my dad had spoken to me like this.”
The other says: “Why on earth are men talking about periods?”

And I always find that second reaction fascinating.

• Because men might not menstruate, but they live in a world with people who do.
• Your daughter might get her first period while you are the only parent at home.
• Your teenage niece might bleed through her clothes while you are driving her somewhere.
• Your girlfriend might wake up at 3am with cramps.
• Your wife might suddenly realise she has run out of period products.
• A colleague might bleed through her trousers during a meeting.
• A girl you coach might quietly tell you she cannot play because she has started her period.

At some point in your life, there is a very good chance a woman or girl will have a period around you.

And at that moment, you have two options. You can be calm, informed and useful. Or you can stand there looking as if nobody ever taught you what a period actually involves.

So perhaps we need a Haynes manual for men and periods. Not a biology degree or a lecture.Just the information every man should probably know.

First: yes, men should know what a period actually is

Let us start with the basics. A period is not simply “a bit of blood once a month”.

Menstruation is part of the menstrual cycle. The lining of the uterus builds up and, if there is no pregnancy, that lining is shed.

That is the bleeding part. But for many women and girls, the experience can also involve cramps, back pain, headaches, bloating, tiredness, diarrhoea, tender breasts, mood changes and generally feeling pretty rotten.

Some barely notice their period. Others are completely floored by it. This is important because one of the least helpful things you can say to somebody struggling with their period is:

“Is it really that bad?”

You do not need to experience period pain to believe someone when they tell you they are in pain.

Second: if a girl tells you she has started her period, do not panic

This one is particularly important for dads.

Imagine your daughter gets her first period while Mum is out. What does she need from you? Probably not a horrified expression or you shouting across the house, “YOUR PERIOD HAS STARTED!”

She needs you to behave as though this is an entirely normal bodily function.

Because it is. Ask her what she needs. Find her a period product. If there is blood on her clothes, help her sort it out without making a huge fuss. If she does not know how to use a pad or period underwear, help her find clear instructions.

And please do not make jokes about her “becoming a woman”.

For a young girl, a first period can already feel confusing, embarrassing and frightening. Your job is not to make it into a ceremony but to make her feel safe. Sometimes the most useful sentence a dad can say is simply:

“Okay. No problem. What do you need?”

Third: learn what period products actually are

Pads.Tampons.Period underwear.Menstrual cups.Period swimwear. You do not have to develop strong opinions about all of them. You just need to know they exist.

If someone asks you to buy pads, do not behave as though you have been sent into a nuclear reactor without protective clothing.

Go to the period aisle. Text them a photo if you are unsure. Ask which absorbency they want. Buy the product. Come home.

And if you are the father of a daughter, having a few period products in the bathroom before she starts menstruating is a very sensible idea.

You keep toilet roll in your house before somebody needs it. Period products should not feel radically different.

Fourth: never announce a period stain

This should be basic human etiquette.

If you notice that a woman or girl has bled through her clothes, tell her quietly and discreetly.

Do not point, laugh, or whisper about it to someone else. And definitely never announce it to the room.

If you have a jumper or jacket she can tie around her waist, offer it. If there is somewhere she can clean up or change, help her get there. Then move on with your life.

Period leaks happen. The embarrassment surrounding them is often far worse than the actual blood.

Fifth: stop using periods as an explanation for every emotion

“Are you on your period?”

Four words capable of making almost any disagreement significantly worse.

Sometimes a woman is angry because she is angry and sometimes she disagrees with you because she disagrees with you. Sometimes you genuinely are being annoying.

Hormonal changes can affect mood for some people, but using menstruation to dismiss a woman’s feelings is patronising and incredibly unhelpful.

If your partner says she feels emotional before her period, listen to her. That does not permit you to diagnose every future disagreement as PMS.

Sixth: period pain is not something every woman should simply put up with

There is an extraordinary tendency to tell girls from a young age that painful periods are just part of being female. For some, mild cramps are manageable.

For others, period pain can be severe enough to disrupt school, work, sleep, exercise and everyday life. So if your daughter is doubled over in pain every month, repeatedly missing school, fainting, vomiting or unable to function normally, do not tell her to toughen up.

Take her seriously and help her seek medical advice.

Being a supportive dad does not require you to know what is causing her symptoms. It requires you to believe her when she says something is wrong.

Seventh: men talking about periods does not take anything away from women

This is perhaps the strangest objection to our Dads and Periods campaign. The idea that periods somehow belong in a conversation that only women are allowed to have.

Women should absolutely lead conversations about their own bodies and experiences. But understanding periods should not be restricted to people who menstruate.

We teach children about digestion even though they are not gastroenterologists and about first aid even though most people are not doctors.

We teach boys about pregnancy even though they will never be pregnant. Knowledge is not ownership. A father understanding periods does not make periods less female. It makes him a better prepared father.

A boy understanding periods does not mean he suddenly understands exactly what menstruation feels like. It means he is less likely to laugh when a girl gets a stain on her skirt.

A male coach understanding periods does not make him an expert on women’s bodies.

It means a teenage player might feel able to tell him why she needs five minutes off the pitch instead of inventing an excuse.

A male partner understanding periods does not mean he has to track every detail of his girlfriend’s cycle. It might simply mean that when she says, “My cramps are awful today,” his response is not, “Again?”

So should men talk about periods?

Yes.

But perhaps “talk” is not even the most important word.

Men should know about periods. Men should be comfortable hearing about periods. Men should know what to do when someone starts one unexpectedly. Men should know how to buy period products. Men should know not to make somebody feel ashamed about bleeding.

And fathers, in particular, should be able to talk about periods with their daughters without embarrassment.

Because there is a bigger point here. Girls learn very quickly which subjects make adults uncomfortable.

If Dad goes silent every time periods are mentioned, she notices. If he leaves every period conversation to Mum, she notices. If he wrinkles his nose at period products, she notices. And she may quietly absorb the message that this part of her body is something men find disgusting or embarrassing.

That is exactly the message we should be trying to dismantle.

At WUKA, we started our Dads and Periods campaign because we want fathers to feel capable of having these conversations.

Not perfectly. Not scientifically. Not with a PowerPoint presentation about the uterus over Sunday lunch. Just normally. Periods happen.

Roughly half the population will experience them at some point in their lives. The other half should probably know what they are.

And if the choice is between a dad who knows what a period is, knows where the period products are kept and can calmly help his daughter when she needs him, or a dad hovering helplessly outside the bathroom shouting, “SHALL I CALL YOUR MUM?”

I know which one I would rather have.

Learn more about WUKA at wuka.co.uk

Weekly app monitoring can reduce fatigue and improve daily life for women with metastatic breast cancer, according to a study.

The approach involves regularly asking patients about their wellbeing through an app and responding quickly when problems are identified.

Germany’s Federal Joint Committee, known as the G-BA, has recommended that the treatment model be incorporated into standard care.

Professor Maria Karsten, senior attending physician at the Charité Breast Cancer Center and initiator of the PRO B project, said: “The new medications often no longer need to be administered at the hospital but can be taken at home.

“As a result, we see patients less frequently at the hospital, and our medical oversight has become somewhat incomplete.

“In order to close this gap and provide patients with close support in spite of the distance, we have developed the PRO B digital treatment concept.”

Around 68,000 women in Germany are living with metastatic breast cancer, meaning the disease has spread to other organs.

At this stage, the cancer is generally considered incurable. Modern treatments can, however, temporarily control the disease and extend life expectancy by several years, with some women able to continue working.

At the centre of PRO B is an app that asks women up to 52 structured questions once a week about their symptoms, daily life and emotional wellbeing.

Questions include whether they have experienced pain, felt too tired to carry out their usual activities or experienced shortness of breath.

An algorithm analyses the answers and immediately alerts the treatment team when relevant changes are detected.

The team then contacts the patient within 48 hours to decide whether any action is needed.

Karsten said: “During these phone calls, for example, we discuss whether the dosage of anti-nausea medication should be adjusted or offer practical tips for managing the various symptoms.

“But we also detect serious side effects more quickly – such as those indicated by a seemingly harmless symptom like fatigue – and can immediately schedule the patient for an appointment at the hospital.”

The study involved 909 women with metastatic breast cancer aged 19 to 81 across 52 breast cancer centres in Germany and followed them for one year.

Around half received PRO B care alongside drug-based cancer treatment.

The other half answered questions about their wellbeing once every three months and were not contacted by their treatment teams in response.

Women receiving PRO B care reported significantly less fatigue, which refers to physical, emotional or mental exhaustion that can severely restrict daily life.

They also rated their physical functioning more positively and required fewer hospital admissions.

Karsten said: “These are effects that have a noticeable impact on the patients’ daily lives; the women are more capable and better able to manage their lives.

“We even have evidence that the PRO B approach extends the remaining lifespan for some patients. We are achieving all of this not through a new medication, but simply by regularly and systematically assessing the women’s well-being and responding accordingly.”

More than 90 per cent of women in the PRO B group said after the study that they wanted the approach to become part of routine care.

Stephanie Neumann-Johnston, 51, who took part in the study, said: “I feel like the app has saved my life several times.

“There are so many situations and incidents that you can’t make sense of – you have so many questions.

“With the app, I can look up common problems and find medically reviewed information, for example, about fatigue. That way, I can help myself, also on the weekends.

“And the personal contact provides me with emotional and medical support.

“For example, I can find out whether I’m allowed to take certain medication for a fever, or get an assessment of my situation: Should I go to the emergency department with these symptoms or not? The app takes a huge weight off your shoulders.”

Based on the medical findings and a health economic analysis, the G-BA recommended in June that PRO B should be incorporated into standard care.

This would allow patients with statutory health insurance to access the model in future when they receive the relevant diagnosis.

PD Dr Christoph Kowalski, department director at the German Cancer Society and a co-author, said: “This recommendation must now be implemented as quickly as possible.

“If a new care concept offers medical and economic benefits, we should not withhold it from the most seriously ill women.”

The health insurance companies involved in the project are also planning further developments so affected women can receive routine PRO B care before its wider introduction into standard care, with access expected to begin this autumn.

The care model will continue under the name “ida”, led by Karsten and her team.

The PRO B project ran from 2020 to 2024 and received around €4.8m from the Innovation Committee of the Federal Joint Committee.

The project was led by Karsten, with consortium partners BARMER, mkk – meine krankenkasse, DAK-Gesundheit, the German Cancer Society and OnkoZert GmbH.

Breast cancer is the most common cancer among women in Germany, with around one in eight expected to develop the disease during their lifetime.

Worldwide, breast cancer is the leading cause of cancer-related deaths.

Despite advances in treatment, 30 per cent of women with early-stage breast cancer and up to 70 per cent of those with lymph node involvement in later stages develop distant metastases, which typically make the disease incurable.

For patients with metastatic breast cancer, treatment aims to prolong life while maintaining the best possible quality of life.

Since 2016, the G-BA has been responsible for supporting new forms of care that go beyond existing standards, as well as health services research aimed at improving healthcare quality in Germany.

Its Innovation Fund is financed through contributions from statutory health insurance plans and the Health Fund.